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Case Challenges in Newly Diagnosed Multiple Myeloma

  • Authors: Sandy Wong, MD
  • CME / ABIM MOC Released: 3/17/2023
  • Valid for credit through: 3/17/2024, 11:59 PM EST
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  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for community-based hematologists/oncologists.

The goal of this activity is for learners to be better able to evaluate patients with newly diagnosed MM and select appropriate therapy in this setting.

Upon completion of this activity, participants will:

  • Have greater competence related to
    • Selecting optimal, individualized first-line therapy in patients with newly diagnosed MM
    • Assessing risk status in patients with MM
    • Managing adverse events associated with therapy for MM
  • Demonstrate greater confidence in their ability to
    • Select personalized therapy for patients with newly diagnosed MM


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  • Sandy Wong, MD

    Associate Professor
    Division of Hematology/Oncology
    Helen Diller Family Comprehensive Cancer Center
    University of California, San Francisco
    San Francisco, California


    Sandy Wong, MD, has the following relevant financial relationships:
    Consultant or advisor for: Catalent Biologics; Dren Biosciences; Sanofi
    Research funding from: Bristol Myers Squibb Company; Caleum; Fortis; Genentech; GlaxoSmithKline; Janssen; Patient Discovery


  • Megan Whitney, DMD

    Medical Education Director, Medscape, LLC 


    Megan Whitney, DMD, has no relevant financial relationships. 

  • Tristin Abair, PhD

    Senior Medical Writer, Medscape, LLC 


    Tristin Abair, PhD, has no relevant financial relationships. 

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.

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Case Challenges in Newly Diagnosed Multiple Myeloma

Authors: Sandy Wong, MDFaculty and Disclosures

CME / ABIM MOC Released: 3/17/2023

Valid for credit through: 3/17/2024, 11:59 PM EST


The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.


Bethany is a 64-year-old principal at an elementary school. She has been married for 40 years and has 2 adult children and 4 grandchildren. She is active and healthy, with a history of well-controlled hypertension and hypothyroidism. She had mild atrial fibrillation following COVID-19 infection 3 years ago, which has now improved and does not require medication. She presents to her primary care physician (PCP) with worsening back pain, and a chest x-ray shows multiple lytic lesions. Biopsy confirms the presence of plasma cells and she is referred to a hematologist. Her hematology workup is summarized in Table 1.

Table 1. Bethany's Hematology Workup

Demographics/patient information
  • 64 years old, female
  • Height: 65 in; weight: 155 lb
  • BMI: 25.8
Personal and family medical history
  • History of well-controlled hypertension, hypothyroidism
  • History of mild atrial fibrillation, not requiring medication
  • Current medications include lisinopril and levothyroxine
  • No major surgeries
  • No family history of cancer
Physical examination
  • No lymphadenopathy
  • Tenderness in lower back
  • BP: 125/65 mm Hg; heart rate: 70 bpm
  • ECOG PS: 0
CBC and blood chemistry
  • WBC count: 9000/mm3
  • HGB: 10 g/dL
  • Platelets: 175 × 109/L
  • Creatinine: 0.8 mg/dL
  • Albumin: 3.2 g/dL
  • eGFR: 70 mL/min/1.73 m2
  • Calcium: 9.7 mg/dL
Myeloma laboratory evaluations
  • M-protein: 1.7 g/dL
  • SIFE: IgG kappa
  • IgG: 2000 mg/dL
  • Kappa free light chain: 356 mg/L
  • Beta-2 microglobulin: 5.7 mg/L
  • Ordered and waiting on results
  • Multiple FDG-avid lytic lesions through the axial and appendicular skeleton
Bone marrow biopsy
  • Bone marrow showed 60% kappa-restricted plasma cells on the core biopsy
Abbreviations: BMI, body mass index; BP, blood pressure; CBC, complete blood count; CT, computed tomography; ECOG, Eastern Cooperative Oncology Group; eGFR, estimated glomerular filtration rate; FDG, fluorodeoxyglucose; FISH, fluorescence in situ hybridization; HGB, hemoglobin; IgG, immunoglobulin G; PET, positron emission tomography; PS, performance status; SIFE, serum immunofixation electrophoresis; WBC, white blood cell.
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